Drug Therapy of Heart Failure in the Elderly

Michael W. Rich, MD


Am J Geriatr Cardiol. 2003;12(4) 

In This Article

Summary and Conclusions

HF is a disorder that disproportionately affects the elderly, yet few of the major HF trials have enrolled substantial numbers of patients over age 75 (the median age of HF patients in the general population), and, with the exception of the DIG trial,[26] none of the published trials have included patients with HF and preserved LV systolic function (which accounts for more than 50% of HF cases in the elderly).[12,13] As a result, there is considerable uncertainty regarding the optimal treatment of HF in persons over 75 years of age. These limitations notwithstanding, available evidence indicates that older patients with systolic HF respond as well to conventional HF therapies as do younger patients, and these therapies, particularly ACE inhibitors and blockers, should be considered standard treatment for systolic HF in all patients regardless of age. Appropriate management of diastolic HF is less well established, both for older and younger patients, and the results of several ongoing randomized trials are eagerly awaited. Finally, in light of the very poor prognosis associated with clinical HF in the elderly, a broad-based effort to reduce the incidence and prevalence of this disorder through targeted and aggressive treatment of hypertension, coronary artery disease, and other risk factors represents an ongoing clinical imperative.

Presented at the Society of Geriatric Cardiology Eighth Annual Scientific Session, Atlanta, GA, March 16, 2002.